197602434-10-30-2024-29-AS-KHEN-DAKUYP-20241031160015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 10/30/2024
Date Signed: 10/30/2024 07:30:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2023 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20230505143457

FACILITY NAME:	GARDENS AT PARK BALBOA, THE		FACILITY NUMBER:	197602434
ADMINISTRATOR:	DION D GALLARZA		FACILITY TYPE:	740
ADDRESS:	7046 KESTER AVENUE		TELEPHONE:	(818) 787-0462
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	120	CENSUS: 104	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	01:56 PM
MET WITH:	Dion Galarza, Executive Director		TIME COMPLETED:	07:35 PM

ALLEGATION(S):

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1. Facility staff did not assist resident with medical transportation needs
2. Facility staff did not treat resident with dignity and respect
3. Facility overcharged resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Christine Yee, conducted an unannounced subsequent complaint visit to conduct further investigation and to deliver the findings of the above allegations. LPA Yee met with Dion Galarza, Administrator and the reason for today’s visit was provided.

On 5/9/23, Licensing Program Analyst (LPA) Christine Yee conducted an initial unannounced complaint visit to investigate the above allegations and met with Katia Arriaga, Business Manager. Per information received, the Administrator was on vacation. The reason for today's visit was explained. During 5/9/23 visit, LPA Yee conducted an interview with Katia Arriaga, Business Manager, at 1:20pm and Javier Rosales, Chef at 2:52pm. A tour of the dining room was conducted at 3:04pm to observe the table set up. Copies of facility documents were provided at 3:15pm.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230505143457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDENS AT PARK BALBOA, THE	FACILITY NUMBER: 197602434
	VISIT DATE: 10/30/2024

NARRATIVE

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Based on information received during the 5/9/23 visit it was determined that additional investigation is
needed to make a finding for the above allegation. Exit interview was conducted and a copy of the report was provided.

Prior to today’s visit, a telephone interview was conducted with the Executive Director at 2:54pm on 10/24/24. On today’s visit, LPA conducted an interview with Staff #3. Per information received through the interviews conducted regarding allegation #1 - Facility staff did not assist resident with medical transportation needs, Resident #1 made transportation arrangements on the morning of the day of the appointment with Staff #3 to be taken to a scheduled dental appointment at 3:30pm on 4/19/23. Resident #1 was specifically told by Staff #3 that they could be dropped off but they could not be picked up after the appointment since staff gets off at 5pm. Resident was okay with being dropped off per information received during staff interviews. Staff offered to make arrangements for the return trip but the resident indicated that they would take Uber/Lyft and charge it back to the facility. The resident was also mad. Staff #3 specifically advised the resident to check with the office regarding reimbursement since alternate transportation is not reimbursable. Staff #3 transported Resident #1 to their appointment and dropped them off around 3:15 or 3:20pm and reminded again that they would not be picked up. The dental visit was completed at around 4:15pm. Resident #1 called the driver for a ride after 5pm and was told that they were already off work and at home. As a result, Resident #1 alleges that the facility staff did not assist resident to make transportation arrangements. Per investigation conducted, there is insufficient evidence to support the allegation that staff did not assist resident with medical transportation needs, therefore the allegation is unsubstantiated at this time

Regarding allegation #2 – staff did not treat the resident with dignity and respect, Resident #1 denies that they were told by staff prior to being dropped off at the dentist that a return ride on the facility van would not be available. Per Resident #1, they were not told until they called the facility to be picked up after the dental visit was concluded. Resident alleges that they were left stranded and they had to make their own arrangement for transportation back to the facility. Per Resident #1, if they had been told in advance, they would have made cheaper arrangements. Per Resident #1, they had to use Lyft and paid $18.96. Per staff interviews conducted, Resident#1 was told that they would not be picked up after the dental appointment due to the lateness of the appointment. The driver goes home at 5pm. Per information received from interviews, there is insufficient evidence to support the allegation that staff did not treat the resident with dignity and respect, therefore the allegation is unsubstantiated at this time.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230505143457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDENS AT PARK BALBOA, THE	FACILITY NUMBER: 197602434
	VISIT DATE: 10/30/2024

NARRATIVE

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Allegation #3 of this complaint alleges that Staff overcharged Resident. Per Resident #1, they wanted to be reimbursed for the Lyft charges incurred for the dental visit on 4/19/23. On the advice of another resident, Resident #1 deducted the Lyft charges from the May 2023 rent without notifying the office of their intention. As a result of the deduction, the rent was not paid in full. The resident was told that the rent was late and Resident #1 would be charged $250.00 for late fees. Per review of Resident #1's signed Admission Agreement the facility states that Residents will be charged $250 if they pay their rent late. Resident #1 did not want to pay the late charges. Per review of facility reports, it confirms that Resident #1 deducted $18.67 from the May 2023 rent and paid back the $18.67 in June 2023. The facility report does not show that the facility charged the resident $250 for late fees. Since the late fees were not assessed, Resident #1 does not have a claim that they were overcharged, therefore the allegation that the staff overcharged the resident is unsubstantiated at this time.

Exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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